The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and <i>Staphylococcus aureus</i> in European hospitals, 2010 and 2011:a multicentre retrospective cohort study

We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34-2.42, HR = 1.81; 95% CI: 1.49-2.20 and HR = 2.42; 95% CI: 1.66-3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2-9.4, 11.5 days; 95% CI: 11.5-11.6 and 13.3 days; 95% CI: 13.2-13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8-5.9) but not hazard of death (1.16; 95% CI: 0.98-1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13-2.35), excess LOS (4.9 days; 95% CI: 1.1-8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae

Review of oral cholera vaccines: efficacy in young children

Cristina Masuet Aumatell1, JM Ramon Torrell1, Jane N Zuckerman21International Health Centre, Preventive Medicine Department, Bellvitge Hospital, L&amp;#39;Hospitalet de Llobregat, Barcelona, Spain; 2World Health Organization Collaborating Centre for Reference, Research and Training in Travel Medicine, University College London Medical School, London, UKBackground: Young children are one of the most vulnerable groups who may be infected with cholera. The following literature review of the efficacy of the currently available cholera vaccines provides a clear evidence base for the clinical administration of cholera vaccine, particularly in an epidemic situation.Aim: To assess the efficacy of oral cholera vaccines in preventing cases of cholera in young children.Methods: A systematic literature review was undertaken for the period 1983 to 2011 using PubMed and the search terms &amp;ldquo;oral cholera vaccines,&amp;rdquo; &amp;ldquo;children,&amp;rdquo; and &amp;ldquo;efficacy,&amp;rdquo; limited to &amp;ldquo;clinical trials&amp;rdquo; and &amp;ldquo;human studies&amp;rdquo;.Results: Oral cholera vaccine provides an acceptable level of protection in young children, with the level of protection being greater at 12 or 24 months following immunization.Conclusions: Children exposed to a potential risk of cholera are recommended to be vaccinated with an oral cholera vaccine, irrespective of whether its constituents include the B subunit.Keywords: efficacy, oral cholera vaccine, childre